Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

972 Menstrual Cycle Disorders for the Generalist

■Find changes that allow greater control over their lives: changes in

diet, exercise, work, recreation

■Isolate specific symptoms, treat with specific therapy: fluid retention

with diuretic therapy, dysmenorrhea with prostaglandin synthesis

inhibitors, calcium supplementation

specific therapy

■Selective serotonin reuptake inhibitors (SSRIs)

■Alprazolam (benzodiazepine) occasionally effective but highly

addictive

■GnRH agonists and/or Danazol

■Oral or IM contraceptives

Side Effects

■SSRIs: dry mouth, tremor, dizziness, somnolence, headaches, con-

stipation, nausea, sweating, insomnia, dyspepsia, libido changes

(decrease, delayed ejaculation, anorgasmia, impotence), abnormal

dreams, weight gain, seizures, anxiety, blurred vision, hyponatremia

■Contraceptives: nausea, vomiting, abdominal cramps, bloating,

breakthrough bleeding, altered menstrual flow, breast tenderness,

edema, headaches, weight changes, rash, ache, thromboembolism,

myocardial infarction, hypertension, hepatic adenoma, stroke,

dizziness, increased risk of depression

GnRH agonists: hot flashes, osteoporosis

Danazol: hirsutism, acne

■Contraindications

■SSRIs: MAO inhibitor use, seizure disorder

■Oral contraceptives: migraine with aura, pregnancy, undiagnosed

vaginal bleeding, breast, endometrial or hepatic cancer, throm-

boembolic disorders, smokers >35 y, CAD, CVD

Special Situations

■Menstrual headache:

➣Association with menses in 60% of women with migraine

➣Menstrual migraines typically without aura

➣Further evaluation needed for acute onset of severe headache

pain, unremitting headaches, vomiting headaches, vision

changes

■Management:

➣Menstrually related migraines: oral and SC sumatriptan

➣NSAIDs

➣Oral contraceptives